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          <h1 class="post-title" itemprop="name headline">022.2019新锐读会 课程笔记《粘接牙科学的基本原理》05</h1>
        

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        <p>第四节 粘接系统与复合材料的兼容性<br>1.粘接系统与复合材料兼容的决定因素<br>a.复合材料的固化<br>b.粘接系统界面的pH值<br>c.特性及是否含叔胺<br>2.粘接系统与复合材料不兼容的原理分析<br>双固化水门汀含叔胺，与BPO反应产生自由基。水门汀里含有抑制剂，让反应不会迅速完成，给医生操作时间。<br>粘接剂如果偏酸性，水门汀偏碱性，会发生酸碱中和，导致聚合能力偏差。<br>如果粘接剂形成的氧阻聚层pH&lt;3，不建议使用含有叔胺的树脂水门汀。<br>直接修复里，绝大多数是使用光固化树脂，没影响。<br>3.粘接系统与复合材料不兼容的解决方案<br>a.改变界面pH值<br>使用界面pH值大于3的粘接剂。去搜自己使用的粘接剂的界面PH值。（3M SBU 为2.7）<br>b.使用自固化活化剂<br>让含有叔胺的双固化树脂水门汀在pH小于3的条件下能正常产生自由基。但会造成粘接强度下降。国内找不到。<br>c.改变复合材料<br>大部分双固化的都含叔胺。<br>不含叔胺的粘固剂：3M 绿巨人或者NX3<br>4.粘接系统与复合材料的临床搭配<br>不想考虑太多，要么选择不含叔胺的水门汀，要么选择pH大于3的粘接剂。<br>第四阶段 修复体的粘接<br>第一章 修复体粘接的概述<br>第一节 修复体材料的变化及分类<br>趋势：金属烤瓷冠数量逐年下降，氧化锆和铸瓷数量逐年上升。<br>非金属材料成为修复的主流。陶瓷和树脂。<br>a.陶瓷的分类<br>1.多晶陶瓷<br>氧化铝，氧化锆<br>2.玻璃基陶瓷<br>长石陶瓷、白榴石、二硅酸锂<br>3.树脂基陶瓷<br>瓷类脆性大，结合树脂的韧性。流体瓷，优韧瓷。<br>第二节 粘接系统的变化<br>树脂修复体粘接系统<br>玻璃基陶瓷粘接系统<br>氧化锆陶瓷粘接系统<br>第二章 氧化锆陶瓷的粘接<br>第一节 概述<br>1.氧化锆陶瓷的临床应用<br>1）美学修复牙科的发展<br>2）强度高于玻璃基陶瓷及氧化铝<br>3）满足今天的数字化牙科<br>4）很好的生物兼容性<br>2.氧化锆陶瓷的成分和加工工艺<br>氧化锆晶体及少部分氧化钇<br>瓷粉-压力压成块-低温烧结-染色-制作修复体-二次烧结。<br>3.氧化锆陶瓷是否需要专业的粘接系统<br>如果备牙可以，未必需要粘接系统。如果条件不好，聚合度大，还是要专业的粘接系统。<br>4.氧化锆陶瓷目前的粘接方法及成效<br>a.玻璃离子及树脂水门汀<br>基牙条件好。<br>b.硅涂层技术<br>硅涂层包裹的氧化铝进行喷砂，使修复体组织面粗糙，硅涂层留在修复体表面。硅烷处理，与硅涂层发生化学结合。硅烷与水门汀形成化学粘接。问题，硅涂层与修复体表面并没有发生化学结合。硅涂层受力可能剥离。<br>c.氧化锆陶瓷组织面喷砂<br>用没有硅涂层的氧化铝喷砂，但与水门汀只有机械结合。有可能水解。<br>喷砂要求：<br>喷砂强度，2.8bar<br>喷砂角度，60度（扫）<br>喷砂距离，1-2cm<br>喷砂时间，20s<br>喷砂砂子粒径，&lt;50μm<br>d.氧化铝喷砂结合氧化锆底涂剂<br>Z-Primer，MDP。<br>临床常用方案。<br>5.氧化锆陶瓷粘接的临床总结<br>固位良好：用啥都行。<br>固位不好：喷砂处理、涂氧化锆涂底剂、双固化树脂水门汀。<br>第二节 氧化锆界面处理<br>1.氧化锆界面处理的原理<br>MDP，与氧化锆和牙齿可产生化学粘接，两性功能基团单体，高度疏水性。<br>2.涂底剂的选择<br>a.形成MDP-Zr化学键的量，必须有足够的MDP<br>专用的MDP量要高于八代粘接剂。<br>b.成膜厚度及界面疏水性<br>专用的最薄<br>c.是否需要固化<br>专用的不需要固化，粘接剂需要<br>因此建议使用专用的氧化锆涂底剂。<br>3.涂布涂底剂的时机<br>试戴之前涂，疏水界面不容易污染。<br>4.涂底剂涂布后的界面变化<br>亲水界面变成疏水界面，需要反应5分钟。<br>5.涂布涂底剂的界面稳定性<br>会被碱性制剂破坏。<br>6.HF硅烷可否处理氧化锆？<br>意义不大。<br>7.唾液污染后的氧化锆界面处理<br>a.污染原理<br>唾液中的电解质：钠、钾、镁、Cl、磷酸盐等会与锆发生反应，使水门汀的化学结合力下降。<br>b.处理<br>①用磷酸<br>适应症：试戴前已经涂布氧化锆涂底剂。<br>②试戴前未用涂底剂，被唾液污染。<br>不能用磷酸处理，可用喷砂或涂布碱性制剂处理。</p>
<p>个人总结：氧阻聚层pH值与水门汀兼容性的问题，pH&lt;3的，需使用不含叔胺的粘固剂（双固化或自固化的），pH&gt;3的，没影响，都可以用。氧化锆修复体的粘接：固位可以的，用什么都行。固位不良的：喷砂+涂底剂+粘接。涂底剂主要成分为MDP，能与牙体和氧化锆均形成化学粘接。应该用专用的涂底剂，而不是用第八代粘接剂含有的MDP来代替。</p>
<p>我发文章的三个地方，欢迎大家在朋友圈等地方分享，欢迎点“在看”。<br>我的个人博客地址：<a href="https://zwdnet.github.io/">https://zwdnet.github.io</a><br>我的CSDN博客地址：<a target="_blank" rel="noopener" href="https://blog.csdn.net/zwdnet">https://blog.csdn.net/zwdnet</a><br>我的微信个人订阅号：赵瑜敏的口腔医学学习园地</p>
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